Stroke Prevention in Atrial Fibrillation: A Clinical Perspective on Trials of the Novel Oral Anticoagulants

Cardiovascular Drugs and Therapy
João Morais, Raffaele De Caterina

Abstract

Atrial fibrillation (AF) is a common heart rhythm disturbance; its incidence increases with age, and it is also an independent risk factor for stroke. Anticoagulation has been proven as the most effective way to reduce the risk of stroke in patients with AF, and vitamin K antagonists have been used for decades as the gold standard treatment. Vitamin K antagonists have a narrow therapeutic window in addition to variable pharmacokinetics and pharmacodynamics, and they frequently interact with food and other drugs, requiring coagulation monitoring to ensure balance between safety and efficacy. The novel oral anticoagulants (NOACs) dabigatran, rivaroxaban, apixaban, and edoxaban selectively target either thrombin or Factor Xa and have predictable pharmacologic profiles, removing the need for routine coagulation monitoring. This article summarizes phase III data in patient subtypes and discusses controversies surrounding AF management with these agents. Results indicate that NOACs in non-valvular AF have an overall improved efficacy-safety profile compared with warfarin. Significantly fewer fatal bleeding events were observed in patients randomized to rivaroxaban, apixaban, or edoxaban compared with those on warfarin, and significan...Continue Reading

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Citations

Jul 23, 2016·International Journal of Cardiology·Victoria Chatzimavridou-GrigoriadouAlexander G Mathioudakis
Jul 8, 2016·The Journal of Pharmacology and Experimental Therapeutics·Xueping ZhouXinkang Wang
Jan 14, 2017·Journal of Medicinal Chemistry·James R CorteMimi L Quan
Dec 7, 2018·Expert Opinion on Pharmacotherapy·Abdalla IbrahimBryan P Yan
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Nov 3, 2017·Heart·Caroline Sindet-PedersenJonas Bjerring Olesen
May 19, 2020·Current Pharmaceutical Design·Paraskevi PapanikolaouDimitris Tousoulis

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Clinical Trials Mentioned

NCT02164864
NCT02415400
NCT02329327

Software Mentioned

ENGAGE AF
PIONEER
RE
ARISTOTLE
AVERROES
ANNEXA
ROCKET AF
XANTUS
AUGUSTUS
REDUAL

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